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NET Santa Rosa Drwsron LOGIN CHECKLIST <br /> CLIENT. JOB# LOG # <br /> Project ID <br /> Samples Received On Checked In on <br /> 1) Custody Seals EJVpresent <br /> NIA ❑ Absent ❑ Broken <br /> 2) Chain of Custody Present ❑ Absent #(s) <br /> Forms Complete ❑ Incomplete <br /> S) Type of packing material used _ ou- . <br /> 4) Temperature(s) . ' C Thermometer#(s) <br /> 5) Sample Container(s) 11Q Intact ❑ Broken <br /> 6) Container Label(s) Match COC ❑ Do Not Match <br /> 7) Sample Volume Sufficient ❑ Insufficient <br /> --A` <br /> 8) Preservative(s) VCorrect ❑ Incorrect ❑ pH verified ❑ Res Cl chk <br /> (CN & PHLs) <br /> 9} Headspace=(VOAs) None ❑-Present=(IisfkD's L-number_viaks affected ,, -- <br /> Sample ID # of Vials Sample ID # of Vials <br /> 10) Form Completed By: Date: <br /> Attach sht06?S, 1KaCVng slip to this form before routing <br /> Problem-Resolution. W 4 - <br /> 1) ❑ Project Coordinator Verbally Informed on <br /> 2) ❑ Client Informed on By <br /> Project Coordinator. Date Resolved ❑ Y ❑ N <br /> Comments <br /> gam1scVognfrm <br />